Provider Demographics
NPI:1841896206
Name:PARK, JUSTIN KYOUK (PHARMD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:KYOUK
Last Name:PARK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N ELLIE ST
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3995
Mailing Address - Country:US
Mailing Address - Phone:714-328-6506
Mailing Address - Fax:
Practice Address - Street 1:45 PEARL ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1832
Practice Address - Country:US
Practice Address - Phone:732-516-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04084400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist